RECONSTRUCTION OF THE SPINAL ACCESSORY NERVE WITH AN ANASTOMOSIS TO THE DORSAL C3 BRANCH - TECHNICAL NOTE

MOST LESIONS OF the spinal accessory nerve are of traumatic origin. If the proximal part is sectioned next to its exit from the cranial base , the reconstruction might be difficult. In such a case, one option is intracranial identification of the spinal accessory nerve and transdu ral interposition of a graft to its distal stump. Cerebrospinal fluid leaks or infections, caudal nerve palsies, or even spinal neurological deficits are possible complications. From more than 70 patients who u nderwent selective peripheral denervations for the treatment of spasmo dic torticollis in our department, we have learned that the dorsal C1- C6 branches can be sectioned without any functional impairment. The do rsal C2 and C3 branches have diameters comparable to that of the spina l accessory nerve. They contain between 600 and 700 myelinated fibers per square millimeter. Therefore, they seem to be ideal proximal donor s for the reconstruction of a severed motor nerve. They may be used in patients with peripheral nerve injuries in the craniocervical region, if other possibilities are not suitable.